Baby wipes: Tradition versus evidence

One of the first pieces of advice I received when we brought MissC home was to use water and cotton only as baby wipes were not suitable for newborns. Obliging as only a new mother is, I went off and cleaned her with water and cloth a process which we have continued given her sensitive skin. I was surprised then to learn that this recommendation is actually not particularly evidence based.
There is good evidence that babies and newborns in particular have 'sensitive' skin. Skin barrier development is incomplete until the age of about 12 months 1, leaving them vulnerable to skin diseases including eczema (20%) and nappy rash (50%). This leads to increased concern about appropriate skin care regimes, however as with eczema there is a huge lack of evidence in most people's recommendations.
There has been an absence of good quality clinical trials on baby skin care and as such most recommendations are based primarily on tradition, culture and prior experience 10,11. Cotton and water is the 'traditional' way of cleaning babies and as such has remained the recommendation in spite of a lack of evidence of its superiority. In fact, at least theoretically water may be a damaging agent as it is more alkaline than the natural pH of a newborn babies skin and it is rapidly absorbed into the skin. Both of these factors risk disrupting skin barrier function.
In the past nappy wipes contained ingredients that were likely to trigger nappy rash however they are mostly alcohol-free, fragrance-free and closer to the natural pH of the skin than water. Several clinical trials have evaluated the safety of alcohol-free nappy wipes to that of cotton and water and have found  no difference in the incidence of nappy rash even when used on already irritated skin 14. One large, high quality randomised controlled trial of newborns found not only no difference in nappy rash reported by the midwife but also no difference in skin hydration, skin surface pH, erythema or presence of microbial skin containments or irritants 2.
Although this is reassuring, unfortunately recommendations can only be applied to wipes that have been tested in clinical trials. These tend to contain features which an average can person can look for such as being close to the natural skin pH (4.9 for a newborn baby) and being alcohol, fragrance, essential oil and soap free. Other factors that are looked at for clinical trials such as the type of surfactant and emollient used and whether the wipes are appropriately preserved to prevent the growth of micro-organisms are impossible for the average person to assess. It is important to realise that most baby products including wipes do not undergo any clinical research to assess the effects of the products on the infants' skin or to assess the claims made by manufacturers. Unfortunately, that means that parents may be best served to stick to the 'tradition and prior experience' given the lack of actual evidence and avoid products unless necessary.
This should not be however at the expense of common sense.The major factors contributing to nappy rash are prolonged contact with urine and faeces, wetness and friction [6-9]. Frequent nappy changes and thorough cleaning remain the best way to prevent nappy rash and if baby wipes, due to their easy portability and usage, make this more likely to occur they should be used.


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